Abstract
The history of pacing to control the atrial arrhythmias of sinoatrial node disease (SND) is reviewed and is demonstrated to have become more physiological in recent years. The importance of atrial stimulation is emphasized especially in the context of the natural history of SND. The role of single and dual chamber rate responsive pacing for correction of chronotropic incompetence is outlined and guidelines are proposed for the management of the different types of SND presentation.
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